Medicare provides healthcare coverage to millions of Americans aged 65 and above, as well as individuals with certain disabilities, including those undergoing kidney transplants. Skyline Benefit specializes in guiding individuals through the complexities of Medicare, ensuring personalized support at every step. Navigating Medicare and End-Stage Renal Disease (ESRD) is crucial for making informed decisions.
How Do I Qualify for Medicare with ESRD?
You may qualify for Medicare if you have ESRD that requires regular dialysis or a kidney transplant, regardless of your age. Here’s what you need to know.
Original Medicare for ESRD:
1. Broad Access to Providers: You can visit any doctor or hospital that accepts Medicare.
2. Flexibility:No network restrictions mean more freedom in choosing healthcare providers.
Medicare Advantage Plans for ESRD:
1. Special Needs Plans (SNPs): These plans are tailored specifically for individuals with chronic conditions like ESRD.
2. Additional Benefits: SNPs may include transportation to medical appointments, meal benefits, in-home support, and care coordination services.
What Changed for Individuals with ESRD Under 65?
Before the 21st Century Cures Act of 2016, individuals with ESRD under 65 were not eligible to enroll in Medicare Advantage plans. However, as of January 1, 2021, this policy changed. Those with ESRD can choose between Original Medicare and Medicare Advantage plans, providing more options to meet their healthcare needs.
When Does Medicare Coverage Start for Kidney Transplants?
Dialysis Treatment:
New Enrollees Under 65: Coverage typically starts on the first day of the fourth month of dialysis treatment if done in a dialysis center. Coverage can begin from the first month of dialysis for those in a home dialysis program.
Age 65 or Older: Coverage can begin anytime after enrollment without a waiting period.
Kidney Transplants:
New Enrollees Under 65: Medicare benefits usually start the month the individual is admitted to the hospital for a kidney transplant and extend for 36 months post-transplant.
Age 65 or Older: Coverage is available anytime after enrollment.
When Do I Apply for Medicare?
Initial enrollment period
You can Apply for Medicare during your seven-month initial enrollment period, which starts three months before your 65th birthday month and ends three months after your birthday month.
Open Enrollment Period (October 15 – December 7)
Anyone with Medicare can join, switch, or drop a Medigap, Medicare Advantage, or drug plan. As long as the plan receives your request by December 7, your coverage will begin on January 1 .
Need Help Selecting the Best Medicare Options for ESRD?
Skyline Benefit is an independent Medicare insurance broker that offers affordable and flexible Medicare options.
Selecting the best Medicare insurance plans and navigating open enrollment can be overwhelming; our mission is to simplify the process and help our clients every step of the way.
Schedule a consultation today. Call us at: (714) 888-5112
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